Aims:
Esophageal, gastric and esophageal-jejunal anastomotic leaks (EEAL) after oncologic
curative surgery are associated with considerable morbidity and mortality. The aim
of the present study was to report our experience and assess the efficacy of self-expanding
metal stents in the treatment of EEAL.
Methods:
We performed a review of patients with stent placement for EEAL from January 2010
until November 2017 at our Hospital. Success was defined as endoscopic defect closure
and resumption of oral intake. Failure was defined as no change in leak size and clinical
signs of sepsis. We included patients with EEAL diagnosed imagiologically, endoscopically
or intraoperative.
Results:
Nine patients (n = 9) patients underwent esophageal stent placement for EEAL. 66%
(n = 6) are females and the median age was 67 years old. The median time between surgery
and the procedure was 13,3 days. There weren't immediate complications after the procedure,
and 7 patients attained immediate technical success. After the procedure, one patient
showed persistence of the leak and was submitted to another upper endoscopy to replace
the stent, and other patient needed a second stent.
One patient developed anastomotic stenosis after stent removal that was successfully
treated with endoscopic
dilatation.
We observed serious complications in two patients (22%): one patient had anastomotic
hemorrhage tree days after the procedure and developed multiorgan failure (MOF) and
another patient without evidence of persistent leak, also evolved unfavorably with
MOF and died.
The mean time to remove the stent was 32,5 days.
Conclusions:
Our results suggest that early stenting is an option to be considered, taking into
account the clinical status of the
patient, in cases of surgical complications after oncologic curative surgery. To access
the real effectiveness and safety of this approach, other studies must be done with
a larger number of patients enrolled.
